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I have a love/hate (mostly love) relationship with antidepressants (ADs).  On the one had, they quite literally saved my life; on the other, the side effects can range from annoying to daunting.

The first time I was prescribed an AD was just after I had graduated from college.  I had been living with undiagnosed depression for a long time, but it had taken a turn for the worse.  Depression can be tricky.  Sometimes it creeps up on you and you don’t realize it until you are neck deep in its black waters.  So it was when I found myself sitting on the edge of the bed, contemplating the loaded pistol I held in my hand.  I sat there, looking calmly at it for what seemed hours.  I wanted to die.  I was not scared, or anxious.  I’m an atheist.  I believe when we die, that’s it.  What held me back, what stopped me, was the thought of my mother finding out her son had killed himself.  It would destroy her, that I can say for certain.  Ultimately, the guilt of that overrode the desire to die.  I put my father’s gun away, and went to bed.

I was still dependent on my parents’ medical insurance at the time, so the next day, I told them that I needed to see a doctor and that I thought I was depressed.  After keeping that secret for so long, the idea of telling them terrified me, but I was at a fork in the road and did not see any other way to go.  When I told them, I expected them to be shocked; they were not.  They knew something was wrong and had been considering talking to me about it, but were afraid that that would be overbearing.  I also learned that my father had been on ADs for 10 years and that his own mother lived with lifelong, chronic depression until her eventual death from lung cancer!  I wished I had known all of that sooner as it would have made telling them about my own depression much easier!  In any case, it did help allay my fears of going to the doctor and explaining that I had suicidal tendencies.

I got in to see the doctor that same day.  He was very nice.  I figured he would refer me to a psychiatrist and told him I didn’t want to go to the psyche ward (I’d read One Flew over the Cuckoo’s Nest!).  He explained that as a GP, roughly 10% of his patients came to him for mental health reasons, most commonly anxiety and depression.  This made me feel a lot less like a “crazy person.”  He also uttered something that I still remember today, he said, “I prescribe ADs everyday. They really should just put it in the water!”  He was obviously joking, but the kernel of truth in that statement told me a lot.  He prescribed my Zoloft (sertraline) and sent me home.  Within eight hours of taking the first pill, I felt like a normal person again.  It was an amazing difference in my entire mental picture.  My perception of everything was more positive and healthy.  Plus, I had no desire to kill myself any longer, which was obviously a relief.  The mental strain of having suicidal thoughts running through one’s mind is absolutely exhausting.

Since then, I have gone on and off ADs several times.  I have come to learn that I will need to stay on ADs for the rest of my life.  My case is genetic, chronic, and it is severe.  Medication is what allows me to live a normal life.  Sometimes I still have depressive episodes, which are absolutely terrible, as I described in an earlier post.  When I have an episode, that’s a good indication that my medical regimen needs an adjustment.  Currently, I take THREE different medications to manage my depression: Zoloft (sertraline), Wellbutrin (bupropion), and Abilify (aripiprazole) which is an anti-psychotic used as an adjunct to ADs (I am not psychotic, thankfully).  Zoloft does have side effects for me, including: difficulty reaching orgasm (anorgasmia) and severe night sweating.  Because Zoloft exhibits the side effect of anorgasmia, or delayed orgasm, it is prescribed off-label for men with premature ejaculation; which I can see why.  The night sweats are terribly annoying.  I often wake up soaked from head to toe, the sheets soaked through.  Gross.  Wellbutrin is wonderful in that it does not seem to have any side effects for me.  Abilify makes my heart race at times, and I sometimes will have a bitter taste in my mouth, no matter what I do.

I once was put on a drug called Effexor (venlafaxine) that gave me horrendous side effects.  These included: severe anorgasmia, retrograde ejaculation, drowsiness, dizziness, night sweats, insomnia, and dry mouth.  I also became hypo-manic (despite not being bipolar) and started doing very impulsive things that were out of my normal behavior.  Needless to say,  I told my doctor I wanted to stop the Effexor and he agreed it wasn’t for me, but he warned that I would need to wean off of it very slowly and carefully.  He was not kidding!  It took months for me to wean off of it, and the withdrawals were awful!  It was like giving up smoking: irritability, feeling sick and achy, headaches, etc.  The worst WD effect is a phenomenon known as “brain zaps.”  It’s difficult to describe, but it feels like an electric shock shooting across/through the brain, accompanied by an audible ZAP sound.

So that’s it in a nutshell as far as ADs are concerned.  As you can see, they have their pros and cons.  For some people, the side effects are totally intolerable and they have to play the unfortunate game of trying out different ADs (there are MANY).  I am fortunate that I have a combo that is currently effective and the side effects are tolerable.  I have to wonder how people managed depression before the advent of these amazing drugs.  Not very well I suppose.

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